Making and removing surgical casts



Sept. 26, 1950 J. A. LUGER 2,523,837

MAKING AND REMOVING SURGICAL CASTS f Filed Feb. 15, 1946 2 Sheets-=Sheet1 J7? We)? Z02 Jase a5 .1 Z ayei" jizarizey Filed Feb. 15, 1946 2Sheets-Sheet 2 Spt. 26, 1950 J. A. LUGER 2,522,537

MAKING AND REMOVING SURGICAL CASTS I72 06;? for Jr arzeey Patented Sept.26, 1950 UNITED STATES PATENT OFFICE 4 Claims.

The present invention relates generally to surgical casts, and inparticular to making cuts or openings in casts. It has particularreference to removing surgical casts.

The conventional way of forming casts is to wind gauze carryingcast-forming substance, usually but not always plaster of Paris in a wetform ready to set, around and around a limb or body until the requiredthickness of cast has been built. Then the multiple layers are allowedto set and dry to ultimate rigidity.

When it is time to remove the cast, various cutting tools are employedto cut through the thickness of the cast to permit its removal.Conventionally on a leg, for example, the cast is out where it is mostconvenient, and on one side followed by spreading open the cut cast. Tomake one cut, it takes usually from to 1 hour with labor andperspiration on the doctors part and with discomfort, nerve-racking andpain to the patient. The task does not arise to the dignity one usuallyexpects in such matters.

The present invention is directed to improvements in forming casts tofacilitate opening or cutting them, especially for removing such casts.In general, the invention contemplates embodying in the cast one or moreribbon-lik elements of strong tensile material, such as metal. Theelements ma be specially made to permit the superimposition of severalsuch elements within the cast. as it is being formed. Also the inventioninvolves the provision and use of a suitable tool cooperative with theelements to cause the cast to be out along the line of an element or anarea of superimposed elements.

It is the general object to form a cast with a contained opening-elementuseful to sever the cast material in a manner somewhat akin to theopening of certaincanned goods having a removable severing strip and awinding key therefor.

It is the general object of the invention to provide ribbon-likeelements having strength to resist tension exerted on the strip to cutthe cast.

It is another object of the invention to provide, on a ribbon-likeelement, teeth or projections which pass through layers of gauze laidover the element, thus to mark the line of the underlying element, andalso to aid in anchoring the element into the cast.

A particular object of the invention is to provide frame-lik ribbon-formstructures so that windows may be provided in the cast.

A particular object is to provide strip-form elements extending thelength of a cast to eiiect a lengthwise severing of the cast.

Various other and ancillary objects and advantages of the invention willappear from the following description and explanation of the inventionas exemplified in the accompanying drawings in which:

Fig. 1 illustrates a strip form of tensile material provided with teeth,to be placed under and to be imbedded within a surgical cast.

. Fig. 2 represents a cast containing two sets of superimposed stripssuch as those in Fig. 1, which are eventually to be used to cut the castover the region of each set. Fig. 2 also shows an opening in the castformed in the practice of the present invention.

Fig. 3 represents a detailed view of the cast structure of Fig. 2,showing the relationships of the removable Strips and of the gauzelayers which form the cast.

Fig. 4 illustrates a winding tool which is einployed for the removal ofthe tensile elements in cutting a cast.

Figs. 5, 6 and 7 each represent modified forms for one or both of thepurposes of the structure in Fig. 1.

Figs. 8 and 9 each represent modified forms of tensile elements in theform of frames to provide openings in a cast.

Fig. 10 illustrates the combined use of frames, such as in Figs. 8 and9, and of cast-removing strips.

The invention is not to be considered as limited to and by the specificembodiments which are illustrated in the drawings merel for the purposeof explaining the nature of the invention.

In Fig. 1 there is illustrated a fragmentary length of strip materialfor use in the present invention. Its detail of structure and dimensionsmay be varied over a wide range according to particular requirements,and also in accordance with the nature of the strip material. Brieflythe strip ll! provides a tensionmember with corners l l preferably sharpand capable of serving toa degree as cutting edges in the removaloperation later described. Associated with the strip l0 are a pluralityof projections, such as pins or teeth I2 projecting substantiallperpendicularly from strip H] in such a manner as to project outwardlyinto the gauze layers being wound to form a cast, when one strip It!lies flatwise beneath the first layer of gauze, and other strips Ill lieflatwise between layers of gauze already applied. The teeth [2, inprojecting through gauze covering the strip Ill, provide landmarks orguides indicating the location of a strip 10 beneath the gauze. Onefunction Of the teeth I2 is to permit a strip Ill to be superimposedover an already placed strip l0. Another function of the teeth I2 is toanchor the strip [0 in the cast. The teeth are preferably provided inpairs of opposite integral teeth as illustrated, projectingsubstantially perpendicularly in one direction from the edges of thestrip l0. Each pair of teeth l2 preferably flares slightly away fromstrip In, so that when another strip I0 is superimp sed pon the areaover a strip carrying the teeth, the flaring teeth I2 permit a compactarrangement of two adjacent superimposed strips with gauze andcast-forming material between them.

By way of exemplifying the particular dimensions of a suitable strip,the following specifications are given: When the strip is of stainlesssteel it may be 0.01 inch thick and inch wide. In length it may vary asrequired, and even be provided in a large spool for severing intodesiredlengths. The teeth i2 at the base are a e inch wide and stand upwardlyfrom the strip lllto a height of A3 inch. The distance between adjacentpairs of teeth may vary as desired, a spacing of 5 inches beingsuitable.

Fig. 2 illustrates a leg is having a plaster cast l4 with inlaid stripsH] of which the ends project. There is a hole H5 in the cast. In forming.a cast, there is first applied a soft felt base 20, (Fig. 3) over whichthe cast-forming gauze is wound. Where stockings are used in aconventional manner under the cast, the felt may be omitted. However,before winding the gauze, opposite regions of the cast,'corresponding tofront and rear seam-lines, are selected and covered with strips l0.These may be adequately held in selected position, if necessary, on thefelt or stocking, by strips Of adhesive tapes or other means, not shown.The strips H} are sufficiently long so that the extremitie l5extend'freely beyond the terminal end regions of the cast M to beformed. In the case of plaster casts, there is provided the conventionalgauze into which plaster is incorporated. This material is dipped inwater for a prescribed length of time, and so wet, is wound about thebody portion to build up a cast. This is conventional practice. The onlychange in building the cast is that it i first wound over the said twounderlying strips l0, letting the teeth project through theseveral'layers of gauze covering each strip ID. These projecting teeth,therefore, mark a channel along the layers of gauze, which. channel isfor the receipt of other strips ID with similar teeth. Before the teethof any strip butthe last are lost from View by a covering layer ofgauze, a new strip Hl'is placed in each channel marked by teeth. Thenumber of'strips Ill-employed in the resulting-superimposition of themdepends upon the thickness to which the cast is to be built and also onthe tooth' length. Ordinarily for the strips Ill specified, a castvarying in thickness from to /2 inch has three to four strips It Thefinal layers of gauze preferably completely cover and hide the teeth ofthe last applied strip if). so that no danger results from projection ofthe teeth through the cast.

Fig; 4 shows a tool 363 also herein called a winding mandrel. The toolfunctions to engage one or more ends of the ribbon-like elements,preferabl one at a time, to roll them out. In the form shown it has acylindrical portion 3! to be rolled'along the cast when a substantiallylinear travel is in order. Thus, by rolling the tool along the cast toremove the topmost tensile element, theintervening cast material is cutand raised and may be rolled tightly onto the tool with the element. Thepressure thus exerted is sufiicient to cause the tensile elements to cutthrough the cast material and form a groove along the cast which has thesame width and location as the element being removed. One element at atime can be removed to cut a deeper and deeper groove.

The cylindrical body portion 3i may be about inch in diameter and about1 inch long axially.

One end of this cylinder has a shank 32 of less diameter carrying asuitable handle 33 to be grasped by the hand for the said rollingaction. The other end of the rolling cylinder is tapered as shown at 34preferably as a cone. The diametrical slot 35 is cut from the end of thetapered portion nearly to the shank end of the rolling cylinder 3 l.Slot 35 may be about inch wide.

The conical end is a frustum on one side of the slot, but the opposinghalf-base'of the small end is extended as a chiselin tool 31, with arounded hump 38 on one face of the chisel, for use as a fulcrum inprying operations. The conical end may be used when openings are cut ina cast as later described.

In operation an extending free end of a tensile element which normallyis bent over as shown in Fig. 2 to the surface of the cast, and coveredwith gauze, is inserted into the slot 35 of the tool 30, to engage itfor extraction by rolling. The winding mandrel is then merely rolledalong the surface of the cast on the line of the element, with littleeffort on the part of the operator. A groove is formed including thetensile element and the cast material above it. It is preferable to takeeach of superimposed tensile elements in turn, thus to deepen thegroove, and in the end to open the groove as a out. With both sets ofopposing strips thus treated, the cast is easily divided into twoportions readily removed. There is no danger of injury to the patient,and no disturbing forces are applied to render the patient uneasy oruncomfortable. In removing a single strip from a plaster cast, a nineyear old child can operate the tool easily.

Fig. 5 shows a modification of the tensile element, illustrated by thestrip form. However, the form of Fig. 1 is preferred even though it maybe more wasteful of material to provide it. In the modification, theteeth do not extend from the edges of the strip 40 as they do from strip10, but they are merely a single string of integral teeth struck fromthe metal as shown at 4|. This form is not preferred, because the strip49 is weakened against tension in the region of each tooth 4|.

Fig. 6 shows another modification which functions equally as well asthat in Fig. 1, but is designed to economize in strip material. Thestrip 43 is a single band without integral teeth and secured to it bywelding, adhesion or any other securing means, is a U-shaped member 44with its terminals providing teeth 45 and 45a and its base providing foranchorage to the strip 43.

Fig. 7 shows another modification in which the guiding teeth are notstrong enough to provide anchorage. It consists of tensile tape 45, wirestaples 4i, and paper mounting 48, The staple 4'! has substantiallyparallel teeth 49 and 49a and a base in the form of an angle the bottomsurface of which lies in a plane, thus to hold the teeth 49 and 49aupright. The paper strip 48 is adhesively secured to the tape 45.

It is to be understood that anchor teeth may be dispensed with, andguidin teeth also, when superimposition is not practiced, or isotherwise efiected.

It is frequently desired to provide openings or windows in a cast sothat treatment or observation may be had through the opening. Thepresent invention ma be employed to form windows, and also has modifiedforms so that the presence of a window in the line of the removablestrips does not interfere with the functioning of the strips.

In Fig. 8 there is shown an oval-shaped tensile ribbon-like elementdesignated 50, having two free ends 5! and 52, each of which is suitablefor engagement by the winding mandrel. The element 5|] is in the form ofa frame to provide an opening in the cast, to be made by removing theone or more of such frames placed in the location of a groove to be cutin the cast. The frame 5|] is herein termed a shim, and where aplurality of them are superimposed, they are identical. In Order toindicate the channel for superimposing one shim over another, suitableguides or teeth are provided, in any suitable form such as abovedescribed. As shown, integral teeth of cat-ear type 53 are disposedaround the periphery. Where it may be desired to indicate the end of acovered shim, one end, such as end 5|, may be upturned to provide atooth as a guide. It is also useful to locate a free end for engaging itfor removal by the winding mandrel. The other end 52 is provided as atapered extension which may be imbedded in the cast so that one mightsearch for it by chiseling or scraping away to locate it,

in order that the winding mandrel may be used.

Also if desired, the tapered end 52 may be turned to an upstandingposition by bending it on any line inwardly from the pointed end 54,thus to penetrate the gauze being wound. It may even project through thefinished cast. When the finished cast is dried, either one of these endscan be readily engaged to remove the strip and cut away the desiredwindow, preferably by removing one shim at a time.

Fig. 9 is a modified form of shim, showing a curved structure in frameform, suitable for placing over a le or arm to provide an opening. Itsbody portion 55 has integral teeth of cat-ear type 56, and two ends 5'!and 58 opposing each other. The end 51 is tapered in the form of a toothso that it may be turned to upstanding position, if desired, tofacilitate locating it or facilitate locating another shim above it inthe cast.

Fig. 10 represents a cast 60 on leg 6|, with provision of shims forproviding an opening over the shin. In the cast the dotted lines 62 and63 represent tensile strips havin their respective ends 64 and 65available for engagement by the mandrel. The inner ends of the strips 62and 63 terminate at the periphery of the desired opening. The area ofthe shims is indicated by the numeral 61, which also designates a grooveformed in the cast by the prior removal of one or more of a plurality ofshims. Fig. 10 also illustrates the mandrel of Fig. 4 being used to windout one of the shims 68, such as those in Fig. 8 or Fig. 9, on theconical portion 34 of the mandrel 30.

The invention is not limited to flat or ribbonlike tensile elementsalthough such are preferred to give the desired width to a cut groove,and also to facilitate the provision of the landmarks. A wire ofcircular or other cross-section may be used, to give a narrow opening orcut in a cast, into which a spreading tool can be inserted. However, itis desirable to roughen or notch a wire, to prevent lengthwise slippingthrough the cast.

From the foregoing description and explanation of the invention it willbe appreciated that numerous modifications and changes may be madewithout departing from the spirit and scope 6 of the invention as setforth in the appended claims.

I claim:

1. A surgical cast including therein a plurality of flat narrow tensileribbon-like elements all of the same width and each having a free end,including one such element at the innermost surface of the cast, saidelements occupying the same area of the cast inedge-over-edgesuperimposition, each element having teeth projecting into the casttoward the outermost surface of the cast for guiding the location of thenext superimposed element and for anchoring each element in the cast,whereby said elements may be Wound from their free ends on a mandrelrunning over the outermost surface of the cast to cut open the castalong the said area.

2. A severing device for a surgical cast comprising a ribbon-likeelement having a free end for engagement by a winding mandrel, saidelement having a. plurality of pairs of integral teeth arranged with theteeth of each pair on opposed regions on the opposed edges of theelement, said teeth projecting substantially perpendicularly to the flatface of the ribbon-like element.

3. The method of making a surgical castwhich comprises forming the castby initially winding cast-forming material over a tensile ribbon-likeelement having a free end for engagement by a winding mandrel, saidelement being in the general form of a frame outlining an opening whichmay be made in the cast, and by thereafter including in the cast beingwound one or more similar elements of the same width each with a freeend, said elements being superimposed edge over edge in the cast,whereby said elements may be wound from their free ends on a mandrelrunning over the surface of the cast thereby to cut the cast over saidarea and provide an opening in the cast.

4. A surgical cast including therein at least two flat narrow tensileribbon-like elements superimposed in the same area, all below the outerlayer of the cast, each element having a free end to be engaged forrolling the element to cut the cast, and also having teeth thereonprojecting into the cast toward the outermost surface of the cast andterminating within the cast, whereby said teeth fix the element onwinding the first layer of cast material over said element, guide theplacement of the adjacent outward element, and anchor the element in thefinished cast against slippage lengthwise.

JOSEPH A. LUGER.

REFERENCES CITED The following references are of record in the file ofthis patent:

UNITED STATES PATENTS Number

